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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 192006411
Report Date: 07/18/2023
Date Signed: 07/18/2023 03:15:02 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/17/2023 and conducted by Evaluator Tiffanie Tran
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20230517115617
FACILITY NAME:MAYWOOD CHILD DEVELOPMENT CENTERFACILITY NUMBER:
192006411
ADMINISTRATOR:JOSEFINA PEREZFACILITY TYPE:
850
ADDRESS:4801 58TH STREETTELEPHONE:
(760) 942-3433
CITY:MAYWOODSTATE: CAZIP CODE:
90270
CAPACITY:48CENSUS: 0DATE:
07/18/2023
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Josefina PerezTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Day care child hit by other day care children due to lack of supervision
Staff do not notify authorized representative of incidents
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA), T. Tran arrived at the above facility for the purpose of concluding the investigation of the above complaint allegations. Upon arrival, LPA met with site supervisor Josefina Perez.Based upon the evidence obtained during the course of the investigation through interviews and record reviews. On 5/17 2023, there were 11 children supervised by 2 qualified teachers and a site supervisor. Facility contends there was no lack of care and supervision because staff observed the incident occurred around 10:50AM, while children and staff were sitting on the carpet waiting for dismissal time, C2 took a wooden counting rod by the sensory area where C1 was sitting below then accidently tapped the other end on the top of C1's head. Staff had confirmed and child’s record revealed no other incidents happened to C1 while in care. Therefore, the evidence does not support, nor disprove the above allegations a child in care was not properly supervised occurred at the facility. Due to incident happened right at dismissal time, parents were informed upon pick up and injury reported was generated after the class ended. Therefore, the allegations have been determined unsubstantiated.
A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the facility representative, Josefina Perez.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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